Skip to main content

Advertisement

SpringerLink
Log in

Clinical significance of inflammatory markers

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Inflammatory markers play a key role in the evaluation of patients with gastrointestinal symptoms. For patients presenting with nonspecific symptoms of abdominal pain and diarrhea, distinguishing inflammatory bowel disease from other disorders can be difficult, and invasive diagnostic procedures may be required. Inflammatory markers can be useful to differentiate patients who may require further workup from those who do not. Several serum, fecal, and other markers are reviewed for their use in clinical practice. Although no single ideal marker exists, a few show promise in diagnosing inflammatory disease, monitoring disease activity, and predicting relapse.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Vermeire S, Van Assche G, Rutgeerts P: Laboratory markers in IBD: useful, magic, or unnecessary toys? Gut 2006, 55:426–431.

    Article  PubMed  CAS  Google Scholar 

  2. Gupta A, Derbes C, Sellin J: Clinical indications of the use of antineutrophil cytoplasmic antibodies and anti-Saccharomyces cerevisiae antibodies in the evaluation of inflammatory bowel disease at an Academic Medical Center. Inflamm Bowel Dis 2005, 11:898–902.

    Article  PubMed  Google Scholar 

  3. Murphy SJ, Ullman TA, Abreu MT: Gut microbes in Crohn’s disease: getting to know you better? Am J Gastroenterol 2008, 103:397–398.

    Article  PubMed  Google Scholar 

  4. Florin TH, Paterson EW, Fowler EV, Radford-Smith GL: Clinically active Crohn’s disease is the presence of a low C reactive protein Scand J Gastroenterol 2006, 41:306–311.

    Article  PubMed  CAS  Google Scholar 

  5. Thalmaier D, Dambacher J, Seiderer J, et al.: The +1059G/C polymorphism in the C-reactive protein (CRP) gene is associated with involvement of the terminal ileum and decreased serum CRP levels in patients with Crohn’s disease. Aliment Pharmacol Ther 2006, 24:1105–1115.

    Article  PubMed  CAS  Google Scholar 

  6. Reese GE, Constantinides VA, Simillis C, et al.: Diagnostic precision of anti-Saccharomyces cerevisiae antibodies and perinuclear antineutrophil cytoplasmic antibodies in inflammatory bowel disease. Am J Gastroenterol 2006, 101:2410–2422.

    Article  PubMed  CAS  Google Scholar 

  7. Jaskowski TD, Litwin CM, Hill HR: Analysis of serum antibodies in patients suspected of having inflammatory bowel disease. Clin Vaccine Immunol 2006, 13:655–660.

    Article  PubMed  CAS  Google Scholar 

  8. Lawrance IC, Hall A, Leong R, et al.: A comparative study of goblet cell and pancreatic exocine autoantibodies combined with ASCA and p-ANCA in Chinese and Caucasian patients with IBD. Inflamm Bowel Dis 2005, 11:890–897.

    Article  PubMed  Google Scholar 

  9. Fleshner P, Ippoliti A, Dubinsky M, et al.: Both preoperative perinuclear antineutrophil cytoplasmic antibody and anti-CBir1 expression in ulcerative colitis patients influence pouchitis development after ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol 2008, 6:561–568.

    Article  PubMed  Google Scholar 

  10. Solberg IC, Lygren I, Cvancarova M, et al.: Predictive value of serologic markers in a population-based Norwegian cohort with inflammatory bowel disease. Inflamm Bowel Dis 2009, 15:406–414.

    Article  PubMed  Google Scholar 

  11. Amre DK, Lu SE, Costea F, Seidman EG: Utility of serological markers in predicting the early occurrence of complications and surgery in pediatric Crohn’s disease patients. Am J Gastroenterol 2006, 101:645–652.

    Article  PubMed  Google Scholar 

  12. Lakatos PL, Altorjay I, Szamosi T, et al.: Pancreatic autoantibodies are associated with reactivity to microbial antibodies, penetrating disease behavior, perianal disease, and extraintestinal manifestations, but not with NOD2/CARD15 or TLR4 genotype in a Hungarian IBD cohort. Inflamm Bowel Dis 2009, 15:365–374.

    Article  PubMed  Google Scholar 

  13. Desplat-Jégo S, Johanet C, Escande A, et al.: Update on anti-Saccharomyces cerevisiae antibodies, anti-nuclear associated anti-neutrophil antibodies and antibodies to exocrine pancreas detected by indirect immunofluorescence as biomarkers in chronic inflammatory bowel diseases: results of a multicenter study. World J Gastroenterol 2007, 13:2312–2318.

    PubMed  Google Scholar 

  14. Lichtenstein GR, Hanauer SB, Sandborn WJ; Practice Parameters Committee of American College of Gastroenterology: Management of Crohn’s disease in adults. Am J Gastroenterol 2009, 104:465–483.

    Article  PubMed  Google Scholar 

  15. Papp M, Norman GL, Altorjay I, Lakatos PL: Utility of serological markers in inflammatory bowel diseases: gadget or magic? World J Gastroenterol 2007, 13:2028–2036.

    PubMed  Google Scholar 

  16. Bossuyt X: Serologic markers in inflammatory bowel disease. Clin Chem 2006, 52:171–181.

    Article  PubMed  CAS  Google Scholar 

  17. Targan SR, Landers CJ, Yang H, et al.: Antibodies to CBir1 flagellin define a unique response that is associated independently with complicated Crohn’s disease. Gastroenterology 2005, 128:2020–2028.

    Article  PubMed  CAS  Google Scholar 

  18. Dotan I, Fishman S, Dgani Y, et al.: Antibodies against laminaribioside and chitobioside are novel serologic markers in Crohn’s disease. Gastroenterology 2006, 131:366–378.

    Article  PubMed  CAS  Google Scholar 

  19. Solem CA, Loftus EV Jr, Tremaine WJ, et al.: Correlation of C-reactive protein with clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease. Inflamm Bowel Dis 2005, 11:707–712.

    Article  PubMed  Google Scholar 

  20. Vermeire S, Van Assche G, Rutgeerts P: C-reactive protein as a marker for inflammatory bowel disease. Inflamm Bowel Dis 2004, 10:661–665.

    Article  PubMed  Google Scholar 

  21. Zilberman L, Maharshak N, Arbel Y, et al.: Correlated expression of high-sensitivity C-reactive protein in relation to disease activity in inflammatory bowel disease: lack of differences between Crohn’s disease and ulcerative colitis. Digestion 2006, 73:205–209.

    Article  PubMed  CAS  Google Scholar 

  22. Henriksen M, Jahnsen J, Lygren I, et al.: C-reactive protein: a predictive factor and marker of inflammation in inflammatory bowel disease. Results from a prospective population-based study. Gut 2008, 57:1518–1523.

    Article  PubMed  CAS  Google Scholar 

  23. Koelewijn CL, Schwartz MP, Samsom M, Oldenburg B: C-reactive protein levels during a relapse of Crohn’s disease are associated with the clinical course of the disease. World J Gastroenterol 2008, 14:85–89.

    Article  PubMed  CAS  Google Scholar 

  24. Ferrante M, Henckaerts L, Joossens M, et al.: New serological markers in inflammatory bowel disease are associated with complicated disease behaviour. Gut 2007, 56:1394–1403.

    Article  PubMed  Google Scholar 

  25. Dubinsky MC, Lin YC, Dutridge D, et al.: Serum immune responses predict rapid disease progression among children with Crohn’s disease: immune responses predict disease progression. Am J Gastroenterol 2006, 101:360–367.

    Article  PubMed  Google Scholar 

  26. Sandborn WJ, Colombel JF, Enns R, et al.: Natalizumab induction and maintenance therapy for Crohn’s disease. N Engl J Med 2005, 353:1912–1925.

    Article  PubMed  CAS  Google Scholar 

  27. Sandborn WJ, Feagan BG, Stoinov S, et al.: Certolizumab pegol for the treatment of Crohn’s disease. N Engl J Med 2007, 357:228–238.

    Article  PubMed  CAS  Google Scholar 

  28. Schreiber S, Khaliq-Kareemi M, Lawrance IC, et al.: Maintenance therapy with certolizumab pegol for Crohn’s disease. N Engl J Med 2007, 357:239–250.

    Article  PubMed  CAS  Google Scholar 

  29. Roseth AG, Fagerhol MK, Aadland E, et al.: Assessment of the neutrophil dominating protein calprotectin in feces. A methodologic study. Scand J Gastroenterol 1992, 27:793–798.

    Article  PubMed  CAS  Google Scholar 

  30. Tibble JA, Sigthorsson G, Bridger S, et al.: Surrogate markers of intestinal inflammation are predictive of relapse in patients with inflammatory bowel disease. Gastroenterology 2000, 119:15–22.

    Article  PubMed  CAS  Google Scholar 

  31. von Roon AC, Karamountzos L, Purkayastha S, et al.: Diagnostic precision of fecal calprotectin for inflammatory bowel disease and colorectal malignancy. Am J Gastroenterol 2007, 102:803–813.

    Article  Google Scholar 

  32. Tibble J, Teahon K, Thjodleifsson B, et al.: A simple method for assessing intestinal inflammation in Crohn’s disease. Gut 2000, 47:506–513.

    Article  PubMed  CAS  Google Scholar 

  33. Gaya DR, Lyon TD, Duncan A, et al.: Faecal calprotectin in the assessment of Crohn’s disease activity. QJM 2005, 98:435–441.

    Article  PubMed  CAS  Google Scholar 

  34. Xiang JY, Ouyang Q, Li GD, et al.: Clinical value of fecal calprotectin in determining disease activity of ulcerative colitis. World J Gastroenterol 2008, 14:53–57.

    Article  PubMed  CAS  Google Scholar 

  35. Scarpa M, D’Incà R, Basso D, et al.: Fecal lactoferrin and calprotectin after ileocolonic resection for Crohn’s disease. Dis Colon Rectum 2007, 50:861–869.

    Article  PubMed  Google Scholar 

  36. Thomas P, Rihani H, Røseth A, et al.: Assessment of ileal pouch inflammation by single stool calprotectin assay. Dis Colon Rectum 2000, 43:214–220.

    Article  PubMed  CAS  Google Scholar 

  37. Wildt S, Nordgaard-Lassen I, Bendtsen F, et al.: Metabolic and inflammatory faecal markers in collagenous colitis. Eur J Gastroenterol Hepatol 2007, 19:567–574.

    Article  PubMed  CAS  Google Scholar 

  38. Calpro AS: PhiCal ELISA test. Available at www.calpro.no. Accessed April 2009.

  39. Sugi K, Saitoh O, Hirata I, et al.: Fecal lactoferrin as a marker for disease activity in inflammatory bowel disease: comparison with other neutrophil-derived proteins. Am J Gastroenterol 1996, 91:927–934.

    PubMed  CAS  Google Scholar 

  40. van der Sluys Veer A, Biemond I, Verspaget HW, Lamers CB: Faecal parameters in the assessment of activity in inflammatory bowel disease. Scand J Gastroenterol Suppl 1999, 230:106–110.

    Article  PubMed  Google Scholar 

  41. Walker TR, Land ML, Cook TM, et al.: Serial fecal lactoferrin measurements are useful in the interval assessment of patients with active and inactive inflammatory bowel disease. Gastroenterology 2004, 126:A215.

    Google Scholar 

  42. Kane SV, Sandborn WJ, Rufo PA, et al.: Fecal lactoferrin is a sensitive and specific marker in identifying intestinal inflammation. Am J Gastroenterol 2003, 98:1309–1314.

    Article  PubMed  CAS  Google Scholar 

  43. Langhorst J, Elsenbruch S, Mueller T, et al.: Comparison of 4 neutrophil-derived proteins in feces as indicators of disease activity in ulcerative colitis. Inflamm Bowel Dis 2005, 11:1085–1091.

    Article  PubMed  Google Scholar 

  44. Parsi MA, Shen B, Achkar JP, et al.: Fecal lactoferrin for diagnosis of symptomatic patients with ileal pouch-anal anastomosis. Gastroenterology 2004, 126:1280–1286.

    Article  PubMed  Google Scholar 

  45. Kaiser T, Langhorst J, Wittkkowski H, et al.: Faecal S100A12 as a noninvasive marker distinguishing inflammatory bowel disease from irritable bowel syndrome. Gut 2007, 56:1706–1713.

    Article  PubMed  CAS  Google Scholar 

  46. Brouwer J, Smekens F.: Instability of fecal lysozyme [letter]. Clin Chim Acta 1991, 201:137–138.

    Article  PubMed  CAS  Google Scholar 

  47. Peterson CG, Eklund E, Taha Y, et al.: A new method for the quantification of neutrophil and eosinophil cationic proteins in feces: establishment of normal levels and clinical application in patients with inflammatory bowel disease. Am J Gastroenterol 2002, 97:1755–1762.

    Article  PubMed  CAS  Google Scholar 

  48. Saiki T: Myeloperoxidase concentrations in the stool as a new parameter of inflammatory bowel disease. Kurume Med J 1998, 45:69–73.

    PubMed  CAS  Google Scholar 

  49. Karbach U, Ewe K, Bodenstein H: Alpha 1-antitrypsin, a reliable endogenous marker for intestinal protein loss and its application in patients with Crohn’s disease. Gut 1983, 24:718–723.

    Article  PubMed  CAS  Google Scholar 

  50. Biancone L, Fantini M, Tosti C, et al.: Fecal alpha-1-antitrypsin clearance as a marker of clinical relapse in patients with Crohn’s disease of the distal ileum. European J Gastroenterol Hepatol 2003, 15:261–266.

    Article  CAS  Google Scholar 

  51. Becker K, Niederau C, Frieling T: Faecal excretion of alpha 2-macroglobulin: a novel marker for disease activity in patients with inflammatory bowel disease. Z Gastroenterol 1999, 37:597–605.

    PubMed  CAS  Google Scholar 

  52. Kapel N, Meillet D, Favennec L, et al.: Evaluation of intestinal clearance and faecal excretion of alpha 1-antiproteinase and immunoglobulins during Crohn’s disease and ulcerative colitis. Eur J Clin Chem Clin Biochem 1992, 30:197–202.

    PubMed  CAS  Google Scholar 

  53. Teahon K, Bjarnason I: Comparison of leukocyte excretion and blood loss in inflammatory disease of the bowel. Gut 1993, 34:1535–1538.

    Article  PubMed  CAS  Google Scholar 

  54. Saverymuttu SH, Peters AM, Crofton ME, et al.: 111Indium autologous granulocytes in the detection of inflammatory bowel disease. Gut 1985, 26:955–960.

    Article  PubMed  CAS  Google Scholar 

  55. Crama-Bohbouth GEBI, Pena AS: Significance of faecal lysozyme excretion and alph-1-antitrypsin clearance in the assessment of activity of inflammatory bowel disease. In Activity Related Abnormalities in Inflammatory Bowel Disease. Edited by Ge B. Woerden, The Netherlands: Huybregts Press; 1998:89–103.

    Google Scholar 

  56. Leddin DJ, Paterson WG, DaCosta LR, et al.: Indium-111-labelled autologous leukocyte imaging and faecal excretion. Comparison of conventional methods of assessment of inflammatory bowel disease. Dig Dis Sci 1987, 32:377–387.

    Article  PubMed  CAS  Google Scholar 

  57. Hove H, Nordgaard-Andersen I, Mortensen PB: Faecal DL-lactate concentration in 100 gastrointestinal patients. Scand J Gastroenterol 1994, 29:255–259.

    Article  PubMed  CAS  Google Scholar 

  58. Hocke M, Richter L, Bosseckert H, et al.: Platelet activating factor in stool from patients with ulcerative colitis and Crohn’s disease. Hepatogastroenterology 1999, 46:2333–2337.

    PubMed  CAS  Google Scholar 

  59. Saiki TMK, Toyonaga A, Ishida H, et al.: Detection of pro and inflammatory cytokines in stools of patients with inflammatory bowel disease. Scand J Gastroenterol 1998, 33:616–622.

    Article  PubMed  CAS  Google Scholar 

  60. Nancey S, Perret-Liaudet A, Moussata D, et al.: Urinary Neopterin is a valuable tool in monitoring Crohn’s disease activity. Inflamm Bowel Dis 2008, 14:1548–1554.

    Article  PubMed  CAS  Google Scholar 

  61. Reinders CI, Herulf M, Ljung T, et al.: Rectal mucosal nitric oxide in differentiation of inflammatory bowel disease and irritable bowel syndrome. Clin Gastroenterol Hepatol 2005, 3:777–783.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Baylor College of Medicine, 1709 Dryden Street, Suite 800, Houston, TX, 77030, USA

    Bincy P. Abraham

Authors
  1. Bincy P. Abraham
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Selvi Thirumurthi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bincy P. Abraham.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abraham, B.P., Thirumurthi, S. Clinical significance of inflammatory markers. Curr Gastroenterol Rep 11, 360–367 (2009). https://doi.org/10.1007/s11894-009-0055-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-009-0055-x

Keywords

Search

Navigation